Where

This is an online event.

Contact

Kari Atkinson
Hemophilia of Iowa
319-721-3964
hoi_president@yahoo.com

2017 Hemophilia of Iowa Membership

You are invited to become a member for 2017 of Hemophilia of Iowa! There are many reasons to join, but the best reason: the people. Meet new parents, children, families, and veteran individuals who have lived with a bleeding disorder for a significant amount of time. Membership is January 1-Dec 31, 2017

* Required information

Personal Information

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  • Membership January 1 – December 31, 2017 Single, Family, Industry Representative, and Friends of Hemophilia of Iowa, Inc. – $25 Family includes residents in the same household with dependent children up to the age of 25. (Dependent children do not have to reside in the parent’s home if away at school or living on their own.) Example of relative would be sister, brother, grandparent, aunt, uncle and/or cousin to the person who has a bleeding disorder. Friends of Hemophilia of Iowa, Inc. are people who do not have a relative with a bleeding disorder but are support people and friends of those who do have a bleeding disorder.

  • Fee

    Type Fee
    $25.00

Membership Questions

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    What is your association to the bleeding disorders community? Check all that apply

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    If you yourself, your spouse or child have a bleeding disorder, which HTC/Hematology Clinic are you/they seen at?

Membership Questions Continued

  • Complete the following information for EVERY family member that is considered part of this membership. (Bleeding disorder Yes = someone who has a confirmed diagnosis and has a treatment plan.)

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Financial Help

  • If financial help is needed with membership, a limited number of scholarships are available. Call Hemophilia of Iowa, Inc. Executive Director at 319-393-4007 for confidential assistance. Assistance will only be considered for those directly affected with a bleeding disorder.

$9,999.99

Payment

Payment Method

  • Please make check payable to:
    Hemophilia of Iowa
    6300 Rockwell Drive NE
    Suite 104
    Cedar Rapids, IA 52402

Payment Summary


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